Clinical and Surgical Correlates of Quality of Life and Fatigue During Breast Cancer Chemotherapy in Indonesia: A Cross-Sectional Study

Abstract

Background: Health-related quality of life (HRQoL) and fatigue during chemotherapy for breast cancer are poorly described in Indonesia. Most women present late and undergo extensive surgery.

Objective: To describe HRQoL and fatigue and their clinical, surgical and sociodemographic correlates in Indonesian women receiving chemotherapy.

Methods: In this cross-sectional study, 102 consecutive women at a tertiary hospital in Palembang (June–July 2025) completed the FACT-G and FACIT-F. Analyses comprised group comparisons, correlations and a four-block hierarchical regression, and an exploratory identification (bounds) analysis.

Results: Stage III–IV disease was present in 62.7%, mastectomy in 75.5% and axillary lymph node dissection (ALND) in 68.6%. Mean FACIT-F was 98.5 (SD 21.2), FACT-G 76.8 (SD 18.5). The derived Fatigue Subscale mean (21.7/52) was far below the German population norm (43.5). FACIT-F fell from 115.6 in stage II to 61.2 in stage IV (η² 0.70; 0.60 after reconciling the stage means). It was lower after mastectomy (−17.3 points; Hedges g = 0.83) and ALND (−22.1; g = 1.12). In the final model (adjusted R² 0.58), stage (β = −0.41), mastectomy (β = −0.28), ALND (β = −0.25) and chemotherapy cycles (β = −0.19) were associated with lower scores. Sociodemographic variables were not (|ρ| ≤ 0.15). The surgical associations were attainable only if mastectomy and ALND were nearly uncorrelated, which was not reported.

Conclusion: Fatigue was severe. HRQoL declined steeply with stage, surgical extent and cumulative chemotherapy. Fatigue screening, lymphedema surveillance and rehabilitation merit evaluation in routine chemotherapy care. Prospective studies must confirm the independent contribution of surgery.